Acute pain management: scientific evidence, fourth edition, 2015

Schug, Stephan A.; Palmer, Greta M; Scott, David A.; Halliwell, Richard; Trinca, Jane

doi:10.5694/mja16.00133

Cited by 236 publications

(340 citation statements)

References 2 publications

(2 reference statements)

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“…It has an onset time of about 30 minutes and a duration of action of 4-6 h after intravenous administration (18,19). Some of its metabolites are actually more active than morphine itself and can accumulate in case of kidney failure (18), so its clinical effect must be carefully monitored.…”

Section: Opioidsmentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

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Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to surgical patients with the aim of enhancing the quality of recovery after surgery (1,2). This strategy translates into faster post-operative recovery and improvements of outcomes. All the ERAS Society guidelines (freely available at www.erassociety.org) take into consideration the perioperative management of analgesia. The role of pain management in ERAS pathways is fundamental, considering the importance of containing surgical stress, reducing pain-related complications and speeding recovery (2-5). Correspondence to: Carlo Del Naja, MD. Casa Sollievo della Sofferenza Hospital, viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy.Email: c.delnaja@operapadrepio.it.Abstract: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

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Section: Opioidsmentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…14 Characteristics ideally required for any new analgesic modality are: efficacy, rapidity of administration, low sideeffects, minimal post-administration monitoring, improved patient satisfaction, and low cost. 9 A novel modality such as ear acupuncture might offer a solution for these issues.…”

Section: Introduction Pmentioning

confidence: 99%

“…8 However, medications have significant side-effects in both the short-and longterm. [9][10][11] Of particular concern is recurrent opioid use, 12 which, in part, can lead to a reluctance to prescribe and administer such medications. 13 Nonsteroidal anti-inflammatory drugs (NSAIDs), another mainstay of ED pain management, also have side-effects especially in the gastrointestinal system and kidneys in the elderly.…”

Section: Introduction Pmentioning

confidence: 99%

Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis

Jan

Aldridge

Rogers

et al. 2017

Medical Acupuncture

111

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Objective: Ear acupuncture might be the form of acupuncture best suited to improving acute pain management in the emergency department (ED). The primary aim of this review was to assess the analgesic efficacy of ear acupuncture in the ED. Secondary outcomes included measures of patient satisfaction, adverse effects, cost, administration techniques, and reduction of medication usage. Methods: Seven databases and Google Scholar were searched up to April 27, 2017, using MeSH descriptors for three overarching themes (ear acupuncture, pain management, and emergency medicine). Meta-analyses were performed in 3 comparator groups: (1) ear acupuncture versus sham; (2) ear acupuncture-as-adjunct to standard care; and (3) ear acupuncture (both as sole therapy and adjuvant) versus control to calculate the standardized mean difference (SMD) and weighted mean difference (WMD) for pain scores out of 10. Results: Six randomized controlled trials and 2 observational studies, totaling 458 patients, were retrieved after exclusions. The meta-analysis used data from 4 randomized studies representing 286 patients. The above 3 comparator groups resulted in SMDs of 1.69, 1.68, and 1.66, and WMDs of 2.47, 2.84, and 2.61 respectively, all favoring acupuncture. Battlefield (ear) acupuncture was the most commonly used technique. There were no significant adverse effects and patient satisfaction improved. Results regarding if acupuncture reduced medication use were equivocal. Significant study bias and heterogeneity were found. Conclusions: While study numbers are limited, ear acupuncture, either as stand-alone or as-an-adjunct technique, significantly reduced pain scores and has potential benefits for use in the ED. Further studies will define acupuncture's role and if it reduces use of analgesic medications.

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“…[175] Similarly, in clinical analgesic trials for chronic pain, detailed phenotyping of patients may provide information related to factors that predict not only the risk of persistent pain, but also the response to treatment. [55] This is particularly relevant given emerging data that mechanisms and efficacy of potential interventions for neuropathic pain differ between males and females.…”

Section: Introductionmentioning

confidence: 99%

Translational studies identify long-term impact of prior neonatal pain experience

Walker

2017

Pain

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Acute pain management: scientific evidence, fourth edition, 2015

Cited by 236 publications

References 2 publications

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis

Translational studies identify long-term impact of prior neonatal pain experience

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